Ziprasidone and Citalopram Use in Pregnancy and Lactation in a Woman With Psychotic Depression

To the editor: Although there is a small body of literature regarding the use of citalopram during pregnancy and lactation, minimal clinical information about the effects of the use of the drug ziprasidone during pregnancy or lactation is available. The present case is of a woman treated with ziprasidone and citalopram throughout pregnancy and lactation, without adverse effects to the mother or infant. This is the first report of ziprasidone use throughout pregnancy and lactation.

Animal studies have demonstrated possible teratogenic effects at ziprasidone doses similar to human therapeutic doses (1), and an abstract described malformations in an infant exposed to ziprasidone in utero (2) . However, the effect on human infants remains unclear. In the present case, use of ziprasidone throughout pregnancy was not associated with complications in the mother or infant. In addition, use of ziprasidone during lactation did not result in any detectable adverse outcomes. Ziprasidone concentrations in breast milk were not determined. However, minimal transfer of ziprasidone into breast milk is expected as a result of its extensive protein binding. This theory is supported by a previous case describing very low or nonquantifiable ziprasidone levels in breast milk (3) .

Although the present report demonstrates that ziprasidone was not associated with reproductive toxicity or behavioral teratogenicity, the drug should be used with caution in pregnancy and lactation until a larger database on safety is available, and consideration should be given to preferential use of antipsychotics with greater established safety.